PLANNING & OPERATIONS COMMITTEE MEETING To improve the lives of people affected by behavioral health and developmental and/or intellectual challenges.

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1 PLANNING & OPERATIONS COMMITTEE MEETING To improve the lives of people affected by behavioral health and developmental and/or intellectual challenges. DATE: Thursday, October 18, 2018 TIME: 5:30 PM PLACE: 1430 Collier Street Board Room, Austin, Texas AGENDA I. Citizens Comments (Presentations are limited to 3 minutes) II. Approval of Minutes from September 20, 2018 Planning & Operations Meeting (pgs. 2-3) III. Recommendation to Approve Listing 1900 Corona Drive and 8606 Colonial Drive for Sale (Goal 3) (Weden, pgs. 5-6) IV. Recommendation to Approve Housing First Oak Springs Facility Naming (Goal 3) (Richards, pgs. 6-8) V. Information Item: FY 18 Planning & Operations Board Dashboard (Goal 3) (Baker, pgs. 9-10) VI. Information Item: Authority Services Focus Consumer Satisfaction and Concerns (Goal 2) (Moscal, Wolf, pgs ) VII. Information Item: Adult Behavioral Health Systems Access (Goal 2) (Dominguez, Franke, pgs ) VIII. Discussion Item: Chief Operations Officer Report (Goals 1-3) (Handley, pg ) Clinical Service Delivery Program Support IX. New Business Combined November/December Committee Meeting December 6, 2018 Identify Consent/Non-Consent Agenda Items X. Citizens Comments Integral Care is committed to compliance with the Americans with Disabilities Act. To request a reasonable accommodation, please call Note: The full packet is available on Integral Care s webpage at: (Under the heading Planning & Operations Committee ) P&O Committee packets will not be available to staff/public at the meeting. Only Agendas will be available.

2 PLANNING & OPERATIONS COMMITTEE MINUTES DATE: Thursday, September 20, 2018 TIME: 5:30 PM PLACE: 1430 Collier Street Board Room Austin, TX MEMBERS PRESENT: MEMBERS ABSENT: OTHER BOARD MEMBERS PRESENT: Dr. Guadalupe Zamora, Emmit Hayes Luanne Southern, Dr. David Springer and Sarah Churchill Llamas None Integral Care staff were present The Chair, Dr. Guadalupe Zamora, called the meeting to order at 5:33 p.m. CITIZENS COMMENTS None. APPROVAL OF MINUTES The minutes of the August 23, 2018 meeting stand approved as submitted. RECOMMENDATION TO APPROVE, IF AWARDED, HEALTH STARTS AT HOME: EXPANDING HOUSING WRAP-AROUND SERVICES AND SUPPORTS - ST. DAVID S FOUNDATION RFP (GOAL 2) Chris Laguna provided the Committee with background information on the St. David s Foundation RFP. The proposal targets low-income residents in affordable housing communities. Will provide $300K over 2 years. Discussion ensued. Emmit Hayes called for a motion to recommend to the Board the approval of proposed recommendation. Dr. Guadalupe Zamora second. All in favor. Motion carried. This item will be added to the consent agenda. RECOMMENDATION TO APPROVE, IF AWARDED, FUNDS FROM AUSTIN PUBLIC HEALTH FOR THE PROVISION OF NON-MEDICAL CASE MANAGEMENT SERVICES TO PEOPLE LIVING WITH HIV (GOAL 2) Emily Johnston provided the Committee with background information about this RFP and grant. Will provide over $195k over 42 months and will provide non-medical case management services to people living with HIV. Discussion ensued. Emmit Hayes called for a motion to recommend to the Board the approval of proposed recommendation. Dr. Zamora second. All in favor. Motion carried. This item will be added to the consent agenda. INFORMATION ITEM: STATE HOSPITAL BED UTILIZATION Lesa Brown-Valades provided the Committee with information on State Hospital Bed Utilization such as the role of the LMHA, hospital bed allocation and bed day capacity allowance. DISCUSSION ITEM: CHIEF OPERATIONS OFFICER (COO) REPORT Dawn Handley provided the Committee with a brief verbal report regarding clinical service delivery and program support. Kim Macakiage also provided the Committee with and update on current measures met and not met. Discussion ensued.

3 Planning & Operations Committee Meeting Minutes September 20, 2018 Page 2 NEW BUSINESS The items listed below were decided for Consent/Non-Consent Agenda: Consent: Recommendation to Approve, if Awarded, Health Starts at Home: Expanding Housing Wrap-Around Services and Supports - St. David s Foundation RFP (Goal 2) Recommendation to Approve, if Awarded, Funds from Austin Public Health for the Provision of Non-Medical Case Management Services to People Living with HIV (Goal 2) Non-Consent: None CITIZENS COMMENTS None. ADJOURNED The meeting adjourned at 6:22 p.m. Guadalupe Zamora Kendra Green, Recording Secretary Date

4 Board of Trustees Planning and Operations Committee October 18, 2018 I. Citizens Comments

5 II. Approval of Minutes from September 20, 2018 Planning & Operations Meeting III. Recommendation to Approve Listing 1900 Corona Drive and 8606 Colonial Drive for Sale (Goal 3) David Weden, Chief Administrative Officer/Chief Financial Officer

6 Questions/Comments? IV. Recommendation to Approve Housing First Oak Springs Facility Naming (Goal 3) Ellen Richards Chief Strategy Officer

7 Overview Integral Care launched Housing First Oak Springs to develop the fundraising campaign Why we need to change name of project Submitted request to Capital One on October 8, 2018 for approval Proposed name Terrace at Oak Springs

8 Recommendation Recommend that the Board of Trustees approve the change of name from Housing First Oak Springs to Terrace at Oak Springs pending Capital One approval. Questions/Comments?

9 V. Information Item: FY 18 Planning & Operations Board Dashboard (Goal 3) James Baker, MD, MBA Systems Chief Medical Officer Integral Care Planning and Operations Committee Dashboard Report through August, 2018 Dimension KPI Definition Psychiatric Evaluation Percent of all psychiatric Access evaluations completed in less than 15 days of request Annual Target Goal 100% Qtr.4 FYTD Actual Status 69% 72% Comment Access Adult Psychiatric EvaluationAccess Percent of all adult psychiatric evaluations completed in less than 100% 68% 72% 15 days ofrequest Child Psychiatric EvaluationAccess Percent of allchild psychiatric evaluations 100% 79% 73% completed in less than 15 days ofrequest IDD intakeaccess Percent of eligibilities evaluations completed 100% 15% 28% in less than 15days Efficiency BudgetedServices Delivered StaffProductivity Percent of Medicaid budget servicesdelivered 100% 72% 78% The productivity percentages are now based on direct service hour expectations (100 for clinic based; 90 for 95% 46% 47% community) per provider. Financial Strength DSRIP Goal Attainment Medicaid Collections Percent of DSRIPmetrics achieved at level required for 100% payment Percent of Medicaidclaims collected at 90 days 100% 72% 80% 95% 96% 96% post billing Quality Customer Satisfaction Abuse/Neglect Allegations Percent of customers who are satisfied Of all customers served, the percent of 95% 90% 91% <1% 0% 0% abuse/neglect People TurnoverRate allegationsfiled Turnover of staff,including voluntary and involuntary separations <20% 3% 25% Vacant Position Fill Rate Vacant revenue generating positions filled within 100% 60% 60% 60 days ofposting

10 Questions/Comments? VI. Information Item: Authority Services Focus Consumer Satisfaction and Concerns (Goal 2) Melody Moscal, CQE, Program Manager Quality Management Phyllis Wolf, LPC S, Ombudsman

11 Integral Care s Commitment Innovation in obtaining consumer experience that informs practice Ensuring a transparent process to hearing and addressing concerns Provision of clinical services that are trauma informed and person centered Quick & easy access to services Ombudsman s Office Functions Managing complaints and appeals process Provide Consultation Help resolve barriers to access services Provide advocate and support Investigate allegations of abuse, neglect and exploitation, and consumer rights violations

12 Ombudsman s Office Functions Liaison with DFPS Provide education Identify trends for quality improvement Facilitates Investigative Review Committee Chairs the Human Rights Committee Facilitates the Appeals Committee Ombudsman s Additional Functions Supporting Network Providers Manage the appeal process Assist providers with complaints or concerns Provide Training and Technical Assistance Help identify gaps in the provider network Locate and outreach to new providers

13 September 1, 2017 August 31 st, 2018 Data Complaints: 538 Consultations 500 External Provider 72 On call for DFPS 82 Consumer meetings 11 scheduled Staff Training 23 IRC 3 Provider Training 5 Data Poor Quality of Service Ombudsman Issues Corrolating with Satisfaction Survey Results 142 Problem with Access to Service 88 Medication Issues 41 Rude / Disrespectful Treatment Affordability Long Wait Environment

14 Opportunities for Better Communication Systemic Changes result in an increase of expressed concerns Open access process versus appointments Service quality complaints vary Some individuals coming to the administrative offices for assistance resulting in a need for identified training Challenges to Collecting Consumer Experience and Introduction of Kiosks The usage of a limited amount of tablets for rotation did not capture all the programs. An element of data bias was present as clinicians would give tablets to clients they finished serving instead of free access to survey. Number of surveys collected impacted by factors such as staff vacations, miscommunications, and Kiosk project also faced delays such as vendor provision of kiosk case and facilities installation delay due to major moves within Integral Care.

15 Consumer Survey Update The current survey has 11 questions using trauma informed care criteria and one question added from a 2018 Joint Commission survey finding 15 sites have functioning kiosks: 15 th Street, ANEW, CARE, Child and Family Services, Dove Springs Adults and Children, E 2 nd, Healthy Community Collaborative, NTP, Next Step, North Service Center, Psychiatric Emergency Services, Safe Haven and The INN. Other programs using handheld tablets include: ACT Team, IDD Intake, Oak Springs with Ra1se and School programs in the queue to be added Consumer Survey Update QM trained staff responsible for the overall function of units as well as the downloading of data monthly. Through Qualtrics, survey results are automatically ed to management monthly for their review. Provided surveys via tablets to SAMSO Providers and eliminated the issues with paper and client non response.

16 Consumer Experience Data Customer Satisfaction Totals and Satisfaction Percentages for Year % 98% 97% 98% 96% 96% % 100% 94% 84% 91% 84% % 81% 80% % 98 40% % % Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Survey Total PCT Kiosk Introduction Comparison of Satisfaction Surveys Collected Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug

17 Satisfaction Responses by Question Q1: I got the services when I wanted: 88.6% Q2: I was treated with respect by staff: 91.0% Q3: I felt understood: 91.6% Q4: I felt staff will do what they say they are doing to do: 89.9% Q5: I felt safe at the clinic: 91.0% Q6: I felt staff believed in me: 90.3% Q7: I would recommend these services to friends and family: 90.8% Q8: My services were explained to me: 91.8% Q9: I was pleased with the services I received: 90.4% Q10: My treatment goals and needs were met: 86.5%

18 And so many consumers said Thank You Integral Care Goals for FY19 Development of a more robust data set for Satisfaction with the inclusion of additional programs and trend analysis for to programs for continuous quality improvement. Development of a more robust dashboard to share with staff and the community the results of satisfaction surveys. Explore other options for data collection with Programs and Communications during strategic planning. Develop a better correlation of the data results from the Ombudsman s Office and Satisfaction Surveys.

19 Questions/Comments? VII. Information Item: Adult Behavioral Health Systems Access (Goal 2) Robert Dominguez, Practice Manager Clinic Ops Craig Franke, Chief Medical Director

20 ABH Clinic Operations Clinic Optimization Efforts Same Day Access to Intake & Psychiatry Implemented across all ABH outpatient clinic sites at the end of May 2018 East 2 nd Street, Rundberg, Dove Springs Spans two areas of measure: DSRIP/CCBHC Access to Services Time to Initial Evaluation: Board of Trustees Dashboard Access: Psychiatric Evaluation Access Adults Time to Initial Evaluation: M1-342 Percent within 10 days M1-390 Mean number of days Strategies for Achieving Same Day Access Realignment of clinic schedules & Staff Roles All clinics are utilizing standardized template structure Uniformity of appointment types built into the schedules to achieve access goals and alignment with productivity (wrvu) and budget goals. Psychiatric Evaluation appointments begin at, or near, the conclusion of an intake service. New workflow implemented to readmit individuals into care using office based case managers and doctors in co visits. Daily management of clinic schedules and templates Backfill Process Cancelled appointments are backfilled one to two days in advance No Shows are backfilled the same day

21 DSRIP/CCBHC Access to Services Percent of New Adult Clients who Received an Intake on the Same Day as First Contact 50% 45% 40% 35% 30% 25% 20% 15% 10% 17% 27% 23% 23% 23% 17% 19% 34% 29% 31% 33% 37% 5% 0% Sep 17 Oct 17 Nov 17 Dec 17 Jan 18 Feb 18 Mar 18 Apr 18 May 18 Jun 18 Jul 18 Aug 18

22 BOT Dashboard Measure Percent Of All Adult Psychiatric Evaluations Completed In Less Than 15 Days Of Request 100% Percent of New Clients who Received a Psychiatric Evaluation within 14 Days after Intake 90% 80% 70% 60% 50% 40% 30% 20% 65% 75% 64% 56% 61% 59% 53% 52% 60% 64% 61% 56% No eval recorded Evals conducted 15+ days after intake Evals conducted w/ 14 days of intake 10% 0% Sep 17 Oct 17 Nov 17 Dec 17 Jan 18 Feb 18 Mar 18 Apr 18 May 18 Jun 18 Jul 18 Aug 18 Percent of New Clients who Received a Psychiatric Evaluation on the Same Day as Intake 50% 45% 40% 35% 30% 25% 20% 15% 10% 15% 23% 19% 13% 18% 14% 15% 13% 24% 34% 32% 31% 5% 0% Sep 17 Oct 17 Nov 17 Dec 17 Jan 18 Feb 18 Mar 18 Apr 18 May 18 Jun 18 Jul 18 Aug 18

23 Questions/Comments? VIII. Discussion Item: Chief Operations Officer Report (Goal 2 & 3) Dawn Handley Chief Operations Officer

24 Questions/Comments? IX. New Business

25 X. Citizens Comments

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